CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 302 207.50 7677.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 605 616.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 258 378.25 13995.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 662 2412.25 89218.25 36.99
TCON-TCON-TRANSITION CONFERENCE 138 141.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1073 3755.00 110891.00 29.53
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 3.00 150.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 55 55.00 2750.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.00 450.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 5.00 277.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 166 212.00 15900.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 164 254.00 14097.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.00 450.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 14 14.00 679.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 10 10.00 485.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 28.00 1358.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 71 70.48 3418.50 48.50
Subtotal (Total Children Is Unduplicated) 309 674.48 40734.00 60.39
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 4.00 200.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 403 614.00 30700.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 73 94.00 2350.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 4.00 200.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 25.00 1250.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 1.00 25.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 392 591.50 29575.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 69 90.00 2250.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 336 2425.25 121212.50 49.98
OCCT-97530-OT SESSION BY LICENSED OT 24 72.00 4887.36 67.88
PHY-97110-PT SESSION BY LICENSED PT 24 70.75 4802.51 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 256 1106.75 75126.19 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 747 138533 71304.10 0.51
Subtotal (Total Children Is Unduplicated) 887 143632 343907.66 2.39
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Total 148061.73 495532.66 3.35
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Number of Children (Unduplicated) With at Least One Service 1388
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Center 57
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 11 16.25 874.00 0.00
S 225 6198.00 12214.44 12214.44
H 0 0.00 0.00 0.00
T 4650 137348.73 337077.22 335631.65
4213 4496.75 145268.50 300.00
Other 3 2.00 98.50 98.50
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Total 9102 148061.73 495532.66 348244.59